Comprehensive analysis of surgical treatments for meralgia paraesthetica: Case series and meta-analysis encompassing results of decompression vs neurectomy.

BACKGROUND

Meralgia paraesthetica (MP) is caused by lateral femoral cutaneous nerve (LFCN) compression. Surgical intervention is considered for refractory cases, with LFCN decompression being the most commonly performed procedures. In this study, we present the clinical outcomes of LFCN neurectomy performed at a single neurosurgical department. Our findings are juxtaposed meta-analysis assessing the success rates of different surgical strategies.

MATERIAL AND METHOD: 14 LFCNs neurectomies were performed in 13 MP patients at our Department between 2015 and 2022. Follow-up evaluations were conducted 1 and 12 months after surgery, and at the time of manuscript preparation. One patient (1 LFCN) was lost to follow-up. Our results are compared with outcomes from a systematic review of studies on LFCN decompression versus neurectomy, identified through 3 databases up to May 11, 2024.

RESULTS

The median duration of symptoms was 1.75 years (IQR: 1.00-3.38), with postoperative follow-up of 5.40 years (IQR: 3.60-8.43). Before surgery, patients reported severe pain, with median VAS score of 8 (IQR: 8-9). Significant pain relief was observed at all postoperative time points. No perioperative complications were noted. Pain severity at any time point was not influenced by symptom duration or follow-up length. A meta-analysis showed that LFCN decompression resulted in significantly poorer outcomes compared to neurectomy: 65 % (95 % CI: 56 %-73 %) vs. 86 % (95 % CI: 72 %-93 %; p < 0.001).

CONCLUSION

The study supports the use of LFCN neurectomy as a more effective treatment compared to nerve decompression, although neurectomy does not guarantee 100 % success (∼90 %).